When Jan Ferguson, RN, was pregnant 21 years ago, she was one of the first organizers of a conference to drum up support to allow freestanding birth centers to open in Illinois.
She had hoped to deliver her own baby in a birth center; however, that child has now turned 20, and Ferguson, a certified nurse midwife (CNM) with Eire Family Health Center in Chicago, has yet to see such a center open in the state. But with legislation passed, her own children might be able to realize her dream.
After eight unsuccessful attempts, legislation, known in birth center circles as Public Act 095-0445, passed in August 2007 allowing a pilot program to establish 10 freestanding birth centers in the state.
From the outside, freestanding birth centers often look more like homes than clinics and provide an option between hospital and home birth for low-risk women. Birth centers are not necessarily connected to a hospital or other medical facility and offer a model of care based on midwifery: natural delivery without intrusive technology in a home-like atmosphere.
Birth center patients tend to have an ongoing relationship with the center and with their caregivers, and receive prenatal care and education in the same familiar environment.
There are a number of advantages to birth centers says Gayle Reidmann, CNM, MS, president of West Suburban Midwife Associates in Oak Park, Ill.
“Birth centers can provide access to underserved populations. Particularly downstate, there are not enough people to deliver babies, and women have to drive two hours to get to a hospital,” says Reidmann, also chair of the Illinois Birth Center Task Force. “Additionally, delivering in a birth center costs one-third to one-half less than delivering in a hospital, and in today’s economy with so many people without health insurance [though many insurance providers cover birth center deliveries], that’s a big deal in any geographic area.”
Illinois LicensingGayle Reidmann, CNM, MS
In California, where Reidmann received her training, and in 36 other states, freestanding birth centers are fairly common. The birth centers in those states operate successfully, but safety concerns, such as proximity to hospitals and lack of emergency surgical facilities, are at the heart of the debate in Illinois.
In the past, the Illinois State Medical Society and the American College of Obstetricians and Gynecologists have spoken out against the centers, citing the inability to provide caesareans as a risk factor.
But according to the Health and Medicine Research Policy group, the cesarean section rate of women who go into labor at birth centers is 4.4%, half that of comparable hospital populations. If a cesearean is necessary, the mother is transferred to a hospital for the procedure.
According to the National Birth Center Study, which surveyed more than 11,000 women who delivered in birth centers, the intrapartum and neonatal mortality rate was 1.3 per 1,000 births compared to the national hospital average of 2.5 per 1,000. There also are fewer episiotomies in birth centers (12% as compared to 90% in hospitals), and breastfeeding is more common.
Ferguson notes a number of physicians believe if an operating room is not around the corner, it’s not safe. Others resist birth centers because of the fear they will take private pay patients away from hospitals. But, according to the Illinois Birth Center Task Force, only 1,500 to 2,000 of the annual 180,000 births in Illinois take place outside of a hospital.
Research about safety concessions regarding hospital proximity, the efforts of advocates to educate the public, and a shortage of obstetricians have been quelling fears.
Rules & Regulations
With specifics and rules still in committee, the new legislation doesn’t mean birth centers will start popping up all over the state any time soon. Currently, the rules state one of the 10 pilot centers must be hospital-owned, three must be located in designated shortage areas, and all must be within 30 minutes of a hospital. If something goes wrong and the patient must be transferred, each birth center has a prior agreement in place with the closest hospital.
Many issues also remain on the table, including eligibility requirements, construction standards, length-of-stay allowances, equipment standards, and staffing requirements. The legislation will make its way to the Illinois Department of Public Health by March, and specific rules will be established. When the rules are announced, the public will have 45 days to weigh in. Final rules are expected in fall 2009.
Support for Centers
Some doctors also believe in the birth center approach to delivery care. “I feel that midwives really focus on labor and delivery as a natural process,” says Andrea Lee, OBGYN, of Eire Family Health Center, who plans to open a birth center. “It’s not an illness; it’s natural and wonderful. They focus on the whole patient. Many doctors do this, as well, but midwives are great at bringing in family members, educating patients about breastfeeding, and taking a holistic approach.”
Birth centers, she adds, allow physicians to keep technology out of the picture when it’s not necessary and allow women to labor at their own pace. “I feel that we’re admitting too many people too early and then inducing them. You can’t manage an early labor like you manage active labor,” says Lee.
In the future, Reidmann hopes birth centers will have a chance to prove themselves during the five-year pilot program and that opportunities for more centers and more choices for women will exist.